Endocrinology
Physician discussions on diabetes management, thyroid disorders, hormonal imbalances, and metabolic conditions.
Recent Discussions
When do you check vitamin D levels in patients with depressive symptoms?
I routinely check 25-OH D in all my patients. Given that half the population is deficient and that we now know the role of vitamin D not only for bones but in mood, cognition, and immunity. We need to be aware of deficiencies and replete if low. Moreover, ideal levels are 60-80, not just over 29 as ...
Do you recommend restarting GLP-1RA after bariatric surgery if they tolerated it before the surgery?
While there are no clear recommendations on whether/when to resume GLP-1 RA after bariatric surgery, current 2025 guideline statements (ASMBS, ADA, AACE, Obesity Society) and expert consensus documents suggest the following approach: Hold GLP-1RA in the acute perioperative period. For daily-dosed ...
Is there any role for bisphosphonate or alternative bone-modifying agents use in SMM in the absence of other indications for its use?
The short answer is no, unless the patient has an indication like osteoporosis. Bisphosphonates have been evaluated in smoldering multiple myeloma in studies performed over 10 years ago. Treatment with pamidronate (D’Arena et al., 2011) or zoledronic acid (Musto et al., 2008) did not affect the time...
What is the rationale behind the Anesthesiology recommendation to hold one dose of weekly GLP-RA prior to general anesthesia?
There is evidence that people treated with GLP-1 receptor agonists (GLP-1RA) more often have residual food in the stomach after an overnight fast and greater gastric volume. There is anecdotal evidence of aspiration events in people treated with GLP-1RA. The ASA statement raises a concern and provid...
What are your thoughts on trending beta-hydroxybutyrate once a diagnosis of DKA is already established?
Beta-hydroxybutyrate (BOHB) ≥3.0 mmol/L is highly sensitive and specific for diagnosing DKA and can be measured through serum or point-of-care testing. However, its role in monitoring treatment response and determining resolution remains debated. The American Diabetes Association recommends continui...
When do you consider changing a patient's levothyroxine dose during hospitalization due to abnormal TFTs, but without clinical evidence of thyrotoxicosis or hypothyroidism?
Thank you for your question. I think this is something we commonly get in the hospital, and we often overreact to it. This was a "Things We Do For No Reason" some time back, and I think they outline the issues well.When people are acutely ill, TSH testing is unreliable. The times when TSH testing is...
How do you manage pregnancy associated osteoporosis in post-partum patients with vertebral fractures?
I would make certain that the patient is getting adequate calcium and vitamin D and maintaining a serum 25-hydroxy vitamin D of at least 30 ng/mL. If the patient is breastfeeding, I would not give a bone active medication until breastfeeding has been halted. I would like a lot more information about...
Would you favor the use of denosumab over bisphosphonate therapy for treatment of osteoporosis in patients who are at high risk for osteoarthritis given recent data suggesting reduced risk of developing knee OA?
Although the overall data to date concerning the impact of denosumab to reduce incident knee OA or lessen established disease remain limited, there are sufficient signals that warrant further investigation and support the need for an appropriately powered RCT with endpoints that include both patient...
How do you approach the choice of basal-bolus insulin vs correctional insulin alone to manage hyperglycemia in a hospitalized older adult with type 2 diabetes and significant frailty?
Frail older adults with type 2 diabetes, compared to their less-frail counterparts, may have less predictable oral intake, and you may have more difficulty obtaining an accurate medication reconciliation. You may need to review facility records or speak to multiple collateral historians to find out ...
How would you counsel patients with type 1 or type 2 diabetes mellitus and heart failure on the use of SGLT-2 inhibitors when they have a history of DKA?
Making a recommendation to prescribe this class will really require a case-by-case clinical assessment. It is clear that SGLT-2 inhibitors are very effective in preventing hospitalization for heart failure, and so we will want to suggest their use whenever possible. But it is also clear that DKA (mo...